Doctoral Degrees (Psychiatry)

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Browsing Doctoral Degrees (Psychiatry) by Subject "Anxiety disorders"

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    The development and validation of the visual screening tool for anxiety disorders and depression in people living with hypertension and/or diabetes
    (Stellenbosch : Stellenbosch University, 2018-12) Ogle, Zimbini; Koen, Liezl; Niehaus, Dana H. J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY : People living with hypertension and/or diabetes have an increased prevalence of depression and anxiety disorders. This contributes to functional limitations, poor quality of life, increased financial burden and increased suffering. The identification of these mental disorders can contribute to addressing the burden imposed by them. However, there are barriers to the identification of these disorders, particularly in the South African context. These include a lack of tools that can be applied to the diverse South African cultural and language groups and people with different levels of education; as well as that a number of screening tools fail to meet acceptability for sensitivity in the South African population. Attempts to improve availability of screening tools for use at primary health care have included the translation of screening tools previously developed in high-income countries. However, translated screening tools are often plagued with methodological flaws. In order to address some of these limitations, visual screening tools for depression have been developed. These tools do not require a patient to be able to read and write, and have been found to be appropriate for use in people with low levels of education. They have been shown to be effective in the identification of depression in low-income countries. In this study, I aimed to develop and validate a visual screening tool for both depression and anxiety disorders in people living with hypertension and/or diabetes for use at primary health care level. The items for the visual screening tool were based on the Hospital Anxiety and Depression Scale (HADS). Compared to similar screening tools, the HADS has been found to be an appropriate screening tool for anxiety disorders and depression in people with diabetes, and those with low levels of education. However, the HADS is only appropriate for people who are able to read and write. My study was divided into two phases with each informing the final conclusion. In phase one (reported as one publication), I developed the visual screening tool items by asking an artist, Ms Jane Metelo-Liquito, to draw pictures depicting symptoms of depression and anxiety disorders. The drawings were based on the HADS. These were shown to a group of participants recruited from the general population, primary health care centres and a maternal mental health clinic. This was to ascertain the applicability of the drawings across cultures, languages and varying levels of education. The findings from phase one of the study indicated which drawings were applicable and appropriate for inclusion in the visual screening tool named the Visual Screening Tool for Anxiety Disorders and Depression (VISTAD). In phase two of the study, I validated the VISTAD. Participants diagnosed with hypertension and/or diabetes were recruited from five primary health care centres in the Eastern Cape. This province has been identified to have a high prevalence of hypertension and diabetes. Using the Mini Neuropsychiatric Interview (M.I.N.I) we demonstrated that 40% of our sample had panic disorder, followed by depression (32%), post-traumatic stress disorder (33%), generalised anxiety disorder (17%), and then social phobia and agoraphobia (10% for both). Current available prevalence rates of depression and anxiety disorders in the hypertension and/or diabetes populations are mostly based on research conducted in high-income countries and as such my results are a valuable addition for researchers and clinicians. Using the WHO quality of life assessment instrument (WHOQOL-BREF) as research tool, I found that our participants reported poor quality of life across the domains of physical health, psychological health and environment, but not for the social relationships domain. There were statistically significant differences in the physical and environment domain of people living with hypertension and/or diabetes comorbid with other medical conditions compared to participants without other medical conditions. The majority of participants in my study had lower levels of education, were unemployed and financial dependent on support from others and our results were largely in keeping with available literature in similar groups. The positive association with the social relationships domain could possibly be explained by the fact that most participants were reliant on interdependent social structures. Only 15% of my sample reported hazardous and harmful alcohol use whilst 17% reported any other drug related problems. These are relatively low levels within the South African context but are likely explained by the fact that the majority of my participants were female and that the sample’s average age was 49. The overarching goal of phase two was the validation of the VISTAD (chapter 4) which was developed in phase one. Validation was done against the M.I.N.I and my findings showed that the VISTAD has high accuracy in detecting depression and moderate accuracy in detecting anxiety disorders in adults with a diagnosis of hypertension and/or diabetes attending primary health care centers. The VISTAD is self-administered and any primary health care worker can easily be trained to score it. I demonstrated that it can be administered to patients independent of level of education, language and cultural background. I believe that the VISTAD represents an important contribution towards furthering the integration of the management of mental health conditions into the primary health care system. Firstly, it addresses the challenges posed by cultural, language, educational and time factors when attempting to screen for common mental disorders. Secondly, the VISTAD includes symptoms of depression and anxiety disorders in one screening tool. Literature recommends that the assessment of depressive disorders should include anxiety disorders since these disorders often co-exist in chronic physical conditions. It is well known and widely reported in the literature that primary health care access to mental health specialists is severely limited. Thus, the true integration of mental health care into primary health will improve the early identification and management of depression and anxiety disorders in people living with chronic illnesses. The availability of simple to use and culturally appropriate tools such as the VISTAD brings this goal much closer to becoming a reality.